Provider First Line Business Practice Location Address:
18251 ROSCOE BLVD STE 201A
Provider Second Line Business Practice Location Address:
18251 ROSCOE BLVD., STE. 201A
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-700-1247
Provider Business Practice Location Address Fax Number:
818-885-0762
Provider Enumeration Date:
10/02/2006